Searching for answers: Shortage of coronavirus tests leads to questions

Amanda Garrett Beacon Journal

Monday

Apr 6, 2020 at 6:02 AM

Retired advance-practice nurse Lorraine B. Fields last week feared a retired firefighter would die in the intensive care unit of Western Reserve Hospital before ever being tested for COVID-19.

She also feared for the man’s wife, who has cognitive issues but still drove her husband to the emergency room, where he collapsed.

Hospital staff sent the wife home to wait for a phone call about her husband’s medical condition. But instead, the woman — showing COVID-19 symptoms herself — went grocery shopping.

And that made Fields fearful for us all.

“I can't believe Summit County has so little testing,” said Fields, who is a close relative of the former firefighter and his wife. “I will not believe any numbers about how many people have (COVID-19) until testing is made available.”

Federal privacy laws prevent hospitals from talking about specific patients. But a spokesman for Western Reserve last week said the Cuyahoga Falls hospital has an ample supply of tests for patients in critical care and for its workforce.

(This story is being provided for free as a public service to our readers during the coronavirus outbreak. Please support local journalism by subscribing to The Times-Reporter at timesreporter.com/subscribenow)

It’s much the same at Summit County’s largest providers, Summa Health and Cleveland Clinic Akron General.

Yet testing for most in Ohio — even those with symptoms of COVID-19 — remains elusive as hospitals and health care systems scramble to invent, collaborate and cajole suppliers to expand and speed up coronavirus testing both now and in the months to come.

Tests hard to get

In mid-March it looked like testing might be widespread in Northeast Ohio.

Thousands of people anxious to find out if their cough, fever or sore throat was COVID-19 sat in their cars waiting at Cleveland Clinic drive-thru testing sites in Cuyahoga County, sometimes arriving hours before testing was scheduled to begin.

“It was a bit of a disaster,” said Dr. Brian Rubin, chairman of the Cleveland Clinic’s Robert J. Tomsich Pathology and Laboratory Medicine Institute. He oversees about 1,500 caregivers and 100 pathologists who, even before the pandemic, processed more than 19 million medical tests each year.

The hospital system, following Ohio public health officials’ guidance, intended the drive-thru testing to help very sick people whose doctors had ordered the COVID-19 test.

But not everyone who turned up had talked to a doctor. And many more had a doctor’s order, but shouldn’t have qualified for testing, which continues to be rationed across Ohio.

“We had thousands of people coming through,” Rubin said.“We learned — all right, we really need to put the brakes on this.”

Within a few days, the Cleveland Clinic revoked permission of many doctors to approve testing.

And while a drive-thru remained open last week, it now handles about 150 tests per day, instead of the 2,000 tests the drive-thrus were collecting at their peak.

It wasn’t sustainable, Rubin said, because the hospital also needed to run tests on its own critically ill hospitalized patients and health care workers throughout its system, including Akron General.

Much of the public health COVID-19 testing guidelines in Ohio involve preserving dwindling supplies of personal protective equipment, the gear health care workers and others need to keep from getting infected themselves as they care for a coming wave of coronavirus patients.

On average, health care workers use about 66 pieces of personal protective equipment — gowns, masks, face shields and more — to care for a single COVID-19 patient every day, according to the Ohio Department of Health.

A critically ill patient who has pneumonia might get the same care as someone with equally serious COVID-19. But hospital staff wouldn’t likely use the same amount of protective equipment, which could be saved for use with patients who do have COVID-19.

“The world was not ready for the amount of testing that needs to be done,” Rubin said.

Setting priorities

Last week, that burden grew when the director of Ohio’s health department said it was taking private lab services too long to process COVID-19 tests, often more than five days.

Dr. Amy Acton, the director of the Ohio Department of Health, then signed an order directing all Ohio hospitals to send COVID-19 testing samples to the state lab or to labs at one of four hospitals: Cleveland Clinic, MetroHealth or University Hospitals, which are all in Cleveland; or Ohio State University Wexner Medical Center in Columbus.

Three shifts are working at the Cleveland Clinic lab seven days per week, along with hundreds of couriers and other staff devoted to COVID-19 testing throughout the hospital system.

When test samples arrive at the lab, they are triaged, not unlike patients. The COVID-19 tests taken at hospitals across Northeast Ohio are sorted by color coding that indicates how quickly results are needed, Rubin said.

Then the triaged samples are loaded into one of three “platforms,” variably automated machines that look like large refrigerators from the outside, he said.

The machines, working with chemicals in a cartridge, reveal which tests are positive, which are negative.

Rubin said the Cleveland Clinic lab at the main campus is adding two more platforms, but because of demand it’s unclear when they will arrive.

Meanwhile, the Cleveland Clinic has acquired much smaller platforms to allow in-house testing at some of its other hospitals, including Akron General.

Akron General on Friday expected to begin processing 40 of its tests each day. It’s the only hospital in Summit County so far to be able to test in house.

Summa and Western Reserve can administer the COVID-19 test, but must then send the tests to outside labs for processing.

If you want a test, however, don’t expect to get one by visiting Akron General.

“To be specific, the in-house testing is only for the sickest patients down there,” Rubin said. The rest of the tests, even from Akron General, will continue to come to the Clinic’s main Cleveland lab, where they will be processed, with results returned within 24 hours of the sample being taken.

Uncertainty

Robin Kuppusamy’s family in Copley heard the news March 23: One of her husband’s office colleagues at a large local manufacturer and distributor had tested positive for COVID-19.

Everyone who worked on the same floor of the office building was asked to self-isolate for 14 days.

“The week before that, I was not feeling good,” she said. “I just felt so tired, like I couldn’t walk tired.”

After her family — her husband and four children, ages 14, 12, 10 and 8 — went into home lockdown, Kuppusamy started regularly taking all of their temperatures.

All of them had low-grade fevers, just under 100 degrees. Soon, they all felt body aches, sort of like the flu, but deeper, she said. “Our knees hurt,” she said.

Kuppusamy talked to the Ohio health department and to Akron General.

“They told me no one in Ohio under (age) 65 could be tested,” she said, and they advised her to try to maintain normalcy.

She and her husband tried to take their dog for a walk. “But halfway through, we both said we didn’t know if we could make it home,” she said. Similarly, the kids rode their bikes, but only to the end of the street.

On Saturday, she said the family was probably 80% to 90% better than they were.

But now, without being tested, they’re left to wonder if they had COVID-19.

“Mentally, staying at home away from everyone is hard,” she said in an earlier email. “It’s even harder when you realize if you do die, you won’t even make it in the count.”

Widespread testing

Health experts, including Ohio’s Dr. Acton, said two types of widespread testing are needed before Ohioans can return to any normalcy after Ohio’s wave of COVID-19 crests, which will likely happen in May.

First, Ohio needs to be able to test millions of people to see who may be infected with the virus, whether they’re symptomatic or not.

At the same time, because Ohio has so few of those tests now, Ohio needs widespread blood testing to show who already had the coronavirus by checking for antibodies.

Those people who test positive for the antibodies can go on with their lives because they likely have immunity against being reinfected by COVID-19 any time soon. Researchers are trying to figure out now how long that immunity lasts.

Rubin of the Cleveland Clinic said not a lot of devices are built for mass testing.

Only one company, Roche, makes a big testing line. It’s called the Roche 8800 and if you run the device 24-7, you could test 2,900 samples per day on one of the lines.

Rubin said the Cleveland Clinic wants two Roche 8800s.

“We have ordered and we’re in a line to get them,” he said, adding that he hopes they arrive in May, but cautions that may be optimistic.

In the meantime, what may help Ohio is appointing a statewide testing coordinator, a sort of air traffic controller who would know where all the tests are in Ohio and which labs at any one moment had the ability to process them, Rubin said.

“It’s not that we don’t know what we’re doing,” Rubin said, “but we’re overwhelmed right now.”

In January, the U.S. wasn’t thinking much about COVID-19 and only woke up to it in late February or early March, said Rubin, who’s been working 12- to 16-hours days, seven days a week, since the crisis began.

Ramping up COVID-19 testing “may seem slow to the public,” Rubin said, “but as a physician whose done testing for 20 years, it’s moving faster than anything I’ve ever seen, by a long shot.”

“All we can do is pray”

Retired nurse Lorraine B. Fields said she found out her relative, the retired firefighter, tested positive for COVID-19.

He continued to struggle Saturday on a ventilator at Western Reserve Hospital, where he hasn’t so far responded to antimalarial drugs often touted by President Donald Trump as a potential cure.

His temperature Saturday was 104.4 and his daughter, who lives out of state, wanted to visit, but has been told she wouldn’t be allowed to see her 74-year-old dad, Fields said,

Meanwhile, the firefighter’s 80-year-old wife remains at the couple’s home alone.

Fields said the woman is still coughing and that her primary care doctor has called repeatedly to check on her.

But still, the woman hasn’t been tested.

“What a terrible process this is and (our family has) resources. Other families don’t,” Fields said. “All we can do is pray.”

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